Trauma and Culture

Culture-specific dimensions of support and care to traumatized individuals and systems.

The Netherlands numbers over three million inhabitants from a foreign background (two million of whom are from a non-western background); in the major cities, more than half the youngsters are currently of foreign origin. Foreigners constitute a high-risk group with regard to developing anxiety disorders, in particular a posttraumatic stress disorder (PTSD). However, the regular evidence-based treatment of anxiety disorders (TF-CBT or EMDR) has little efficacy and cost-effectiveness for this group. For instance, there are indications suggesting that the psychotherapeutic treatment of foreign clients is more often problematic (in terms of drop-out, for example, which amounts to 45% among foreign clients versus 28% among the native population) due to various cultural barriers (such as language barriers and a difference in explanatory models for disease). This leads to substantial adverse psychosocial consequences for the client (therapies do not bring about sufficient symptom reduction) as well as major economic consequences because of the long-term problems that limit full participation in society, for instance in the field of labour participation.

The care organizations resorting under Arq Psychotrauma Expert Group have considerable numbers of (non-western) foreigners among their treatment populations. Thus, refugees constitute more than half of the entire patient population of Foundation Centrum ’45, while a considerable group of foreigners is being treated for job-related problems in the Institute for Psychotrauma (IVP) and it is only patients from a refugee background that are treated at Equator. However, the development area does not only involve refugees and asylum seekers but also second- and third-generation (and therefore Dutch-language) foreigners. Central here are job-related traumatic experiences (such as violent aggression incidents) but also survivors of (domestic) violence, street violence, or accidents or disasters.

The Arq development area ‘Diversity and trauma’ aims to optimize intercultural care and make it evidence based – both as to prevention and support and as to psycho-education and (specialist) care. The development area seeks to be directly connected to treatment practices by supporting everyday practice, encouraging innovation and through being fed questions from actual practice. Another aim is to disseminate the knowledge and expertise existing within Arq among other mental-health organizations wishing to optimize their care to traumatized foreign patients. The intercultural know-how existing within Arq is given expression in training/courses and applied intercultural competences (for instance, using the Cultural Interview in diagnostics and knowing how to deal with interpreters during treatment). The development area is further aimed at scientific research into predictive factors of complaint course and treatment efficacy (by means of analyses of patient profiles and treatment outcomes) and at determining characteristics of effective culture-sensitive PTSD treatment.

A culturally competent approach to trauma treatment has as yet not been adopted widely within mental healthcare due to a shortage of specialized therapists and training programmes for therapists tailored to the specific problems of foreigners. This creates a niche where Arq can present itself very well as a pioneer – both in the Netherlands itself and internationally.